Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis

• Published in: Cochrane database of systematic reviews 2023-02, Vol.2, p.CD013733-CD013733
• Main Authors: Smith, Sherie, Calthorpe, Rebecca, Herbert, Sophie, Smyth, Alan R
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adult; Anti-Bacterial Agents - therapeutic use; Child; Cystic Fibrosis - complications; Digital Technology; Humans; Nebulizers and Vaporizers; Quality of Life
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD013733.pub2

Improved understanding and treatment of cystic fibrosis (CF) has led to longer life expectancy, which is accompanied by an increasingly complex regimen of treatments. Suboptimal adherence to the treatment plan, in the context of respiratory disease, has been found to be associated with poorer health outcomes. With digital technology being more accessible, it can be used to monitor adherence to inhaled therapies via chipped nebulisers, mobile phone apps and web-based platforms. This technology can allow monitoring of adherence as well as clinical outcomes, and allow feedback to both the person with CF and their healthcare team. To assess the effects of using digital technology to monitor adherence to inhaled therapies and health status in adults and children with CF. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.  Date of last search: 28 October 2021. We also searched Embase and three clinical trial registries and checked references of included studies. Date of last search: 9 November 2021. We searched for randomised controlled trials (RCTs) looking at the effects of a digital technology for monitoring adherence of children and adults with CF to inhaled therapies. Two review authors screened the search results for studies eligible for inclusion in the review and extracted their data. We used Risk of Bias 2 for assessing study quality. We assessed the overall certainty of the evidence using GRADE. We included two studies in our review, with 628 participants aged five to 41 years. There was one study each for two different comparisons.  Nebuliser target inhalation mode versus standard inhalation mode The included parallel study was carried out over 10 weeks after a run-in period of four to six weeks. The study compared the effects of a digitally enhanced inhalation mode (target inhalation mode) for nebulised antibiotics compared to standard mode in children attending a regional CF clinic in the United Kingdom. The study's primary outcome was the time taken to complete the inhaled treatment, but investigators also reported on adherence to therapy. The results showed that there may be an improvement in adherence with the target inhalation mode when this intervention is used (mean difference (MD) 24.0%, 95% confidence interval (CI) 2.95 to 45.05; low-certainty evidence). The target inhalation mode may make little or no difference to forced expirator